3 Steps Help You Master Thyroid Testing Coverage Rules

You need to know frequency limits, acceptable diagnoses
According to CMS data, 84443 is the seventh most-frequently reported code by endocrinologists. But even though you may bill this code often, you may not know all of its pitfalls. As long as you list your diagnoses in the correct order, avoid inappropriate bundling combinations and watch your frequency guidelines, you can conquer your thyroid testing problems before they start.
Know the four main tests: If a physician wants to screen for thyroid problems, the TSH test (84443, Thyroid stimulating hormone [TSH]) is the most common test choice, says Julio Cortes Sr., owner and director of Unilab of Dade in Ft. Lauderdale, Fla. After an endocrinologist treats a patient for a thyroid condition, he will often order a combination of tests to obtain more detailed information, Cortes says. For example, your endocrinologist may order three thyroid tests to assess a patient's progress during or after treatment for hyperthyroidism (242.9x):

84436 -- Thyroxine; total (often ordered as T4 or TT4)


84439 -- Thyroxine; free (often ordered as FT4, Free T4, or FTI)


84443 -- Thyroid stimulating hormone (TSH).

Another fairly common test is 84479 (Thyroid hormone [T3 or T4] uptake or thyroid hormone binding ratio [THBR]).
3 Action Points Ensure Coverage
Be aware that not all insurers cover the same diagnoses. Endocrinologists order thyroid function tests to diagnose thyroid disease of over- or underproduction of hormones, when clinical signs and symptoms indicate possible abnormalities of the thyroid or pituitary glands. Medicare and many third-party payers consider thyroid testing reasonable and necessary to:


confirm or rule out primary hypothyroidism (244.9) or hyperthyroidism (242.9x)

distinguish between primary (244.9) and secondary hypothyroidism (244.8)

monitor progression of disease and therapy in patients with thyroid dysfunction
monitor neoplasm of the thyroid (193) or other endocrine glands.

Pay attention: Medicare's National Coverage Decision (NCD) on thyroid testing provides an exhaustive list of all the covered diagnoses. This list includes a broad spectrum of diagnoses, from definitive diagnosed conditions like thyroiditis (245.0-245.9) to suspicious signs and symptoms like depression (311), abnormal weight gain (783.1) and nervousness (799.2). Familiarize yourself with this list to avoid being caught off-guard by a denial. Carriers may vary as to which diagnoses they cover, so your best bet is to ask first if you have any doubt about coverage, says Anita Carr, CPC, business office manager and assistant practice manager of Endocrine and Diabetes Associates in Louisville, Ky.
No screenings allowed: Medicare and most other insurers do not cover [...]

- Published on 2004-07-21